We moved to Italy in February 2025, first living in Genoa and then moving to Lecce in October 2025. In Lecce we bought a palazzo built in 1731 in the historic center, which we are now renovating. The renovation will ultimately cost more than what we originally paid for the property and will take about a year to complete.

Living in Italy, and particularly in southern Italy, is an intense experience with many positives and many negatives. For us, however, the positives greatly outweigh the negatives.

When we were considering moving to Italy, the quality of the healthcare system was a major factor in our decision. I am 81 years old and in excellent health, but I also recognize that as I age, healthcare will inevitably become a larger part of my life.

We are financially comfortable and can afford excellent healthcare. While the United States and the Netherlands provide extraordinary healthcare for people who can pay for it, quality alone is not the only factor that matters.

Healthcare System Comparison

Comparison of healthcare systems for wealthy/internationally mobile individuals versus average/middle-income citizens.

Country	Rating for Wealthy / Internationally Mobile Person	Rating for Average / Middle-Income Person
USA	9.5/10	4–7/10
Netherlands	8.5/10	9–9.5/10
Israel	8.5–9/10	8.5–9/10
Italy	7.5–8.5/10	8–8.5/10

Country	Main Strength	Main Weakness
USA	Best advanced and specialist medicine in the world if you can pay	Extremely unequal, expensive, fragmented
Netherlands	Best balanced overall system for ordinary citizens	Can feel rigid and overly protocol-driven
Israel	Excellent doctors, innovation, and relatively fast access	Crowding and pressure on the system
Italy	Very affordable with surprisingly good doctors and outcomes	Bureaucracy, waiting times, regional inconsistency

We have now lived in four countries: the United States, Israel, the Netherlands, and Italy. That has given us an unusual perspective on how healthcare systems actually function in real life rather than simply on paper.

The Italian System

Italy has a universal public healthcare system called the Servizio Sanitario Nazionale (SSN). In practice, however, healthcare in Italy operates through three overlapping systems: the public system, the private system, and a hybrid approach that combines the two.

The public system is funded primarily through taxes and provides broad coverage including hospital care, specialists, surgeries, imaging, medications, and emergency services. Like many European systems, it is organized around a family doctor who coordinates referrals and access to specialists.

The great strengths of the Italian public system are universal access, financial protection, and, in many cases, very high-quality physicians. The weaknesses are bureaucracy, waiting times, and significant regional differences in quality and organization.

Private healthcare in Italy is also widely available and, from an American perspective, surprisingly affordable. Seeing a specialist privately often costs about 125 euros or less. Imaging and diagnostic testing are similarly inexpensive compared to the United States, and appointments are usually much easier to obtain quickly.

Many doctors work in both the public and private systems. In fact, you may see the very same physician either publicly or privately. The difference is often not the quality of the doctor but the speed and convenience of access.

Many Italians carry private insurance, although the premiums reflect the lower overall costs of healthcare in Italy. However, insurance can become expensive for people over 70, and at my age it is difficult or impossible to obtain comprehensive coverage from an Italian insurer. International insurance is available but can be extremely expensive.

The Hybrid Model

Our own strategy has evolved into what I would call a hybrid model.

Because of our visa status, we are required to carry health coverage, so we enrolled in the SSN. It costs us approximately 2,500 euros per year for the two of us. We view the SSN as our safety net for serious illness, hospitalization, or expensive long-term treatment. I also continue to have Medicare in the United States, which provides another layer of backup if we ever needed to return to America for treatment. My wife will become eligible for Medicare in a few years.

For routine care and specialist consultations, however, we generally see doctors privately and pay directly out of pocket. In most cases, this has worked very well.

One thing that has impressed me enormously is the affordability of medications. I take a biologic medication for psoriasis that would cost approximately 20,000 euros per year in the United States. In Italy, through the SSN, I pay nothing for it. Some medications are not covered, but even those are often reasonably priced.

So far, we have not had major problems obtaining specialist appointments or laboratory tests.

Language, however, can be a real issue. Many of the doctors we have seen speak little or no English, and our Italian is not yet strong enough for complicated medical conversations. As a result, we often bring someone with us to help translate.

Dental care has also been a revelation. We found an excellent dentist, and I recently had two implants done for roughly 25 percent of what the same treatment would have cost me in the United States. Last year I purchased a hearing aid in America and now regret doing so. I later discovered I could have bought the identical device in Italy for perhaps 40 percent of the American price.

There are also excellent medical centers in Italy, particularly in Milan, that offer comprehensive medical evaluations and advanced diagnostics. We will probably do a major preventive “deep dive” evaluation every year or two.

One thing I have come to realize is that evaluating a healthcare system is more complicated than simply asking which country has the “best medicine.”

The United States may well have the most advanced healthcare system in the world for people with money. But healthcare is not only about technology and specialists. It is also about stress, accessibility, affordability, quality of daily life, and the absence of fear.

The Italian Health Care System can be a reason for moving to Italy

n America, many people worry constantly about costs, insurance approvals, and financial exposure. In Italy, the frustrations are different. They are more likely to involve bureaucracy, waiting times, or organization. But the fear of financial ruin because of illness is far lower.

As we age, quality of life becomes increasingly important. Italy offers something that statistics alone cannot fully capture: a healthier pace of life, stronger human relationships, lower stress, and the ability to access decent medical care without feeling trapped inside an enormous financial machine.

Bottom line: healthcare should not be viewed as an obstacle to moving to Italy as an expatriate. In many ways, particularly for retirees coming from the United States, it may actually be one of the strongest arguments in favor of making the move.